| NPI | 1356895676 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WI 13497) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MN 11732) |
| Enumeration Date | 2016-08-04 |
| Last Update Date | 2022-11-01 |